Archived: Dr Iftikhar Ali Also known as Halfway Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Iftikhar Ali on 26 January 2016. Breaches of the legal requirements were found.

• The practice had been unable to demonstrate all appropriate recruitment checks had been undertaken prior to directly employing locum GPs.

• The practice was unable to demonstrate they had a system for the routine management, testing and investigation of legionella (a germ found in the environment which can contaminate water systems in buildings).

• The practice was unable to demonstrate they were able to respond to a medical emergency, in line with national guidance, before the arrival of an ambulance.

• Although the practice carried out clinical audits, they were unable to demonstrate how these were driving quality improvement.

• The practice was unable to demonstrate that locum GPs employed directly were up to date with attending mandatory courses or had received annual appraisals.

• The practice had a number of policies and procedures to govern activity. However, some were not dated so it was not clear when they were written or if they were up to date.

• The practice had been unable to demonstrate there was a programme of contunous clinical audit which was used to monitor quality and to make improvements.

• The practice had failed to identify or consider some potential risks. For example, the potential risk of infection from legionella in the building’s water system and the risks associated with failing to carry out all recruitment checks prior to the direct employment of locum GPs.

Following the comprehensive inspection, the practice wrote to us to tell us what they would do to meet the legal requirements in relation to the breaches.

We undertook this focussed inspection on 19 October 2016, to check that the practice had followed their plan and to confirm that they now met the legal requirements. At our focussed follow-up inspection on 19 October 2016, the practice provided records and information to demonstrate that the requirements had been met. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Iftikhar Ali on our website at www.cqc.org.uk.

The areas where the practice should continue to make improvements are:

• Ensure further risk assessment is carried out to include all potential risks from legionella (a germ found in the environment which can contaminate water systems in buildings).

• Create a practice website.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Iftikhar Ali (also known as Halfway Surgery) on 26 January 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks of directly employed locum GPs and legionella (a germ found in the environment which can contaminate water systems in buildings).
• The practice was unable to demonstrate they were able to respond to a medical emergency, in line with national guidance, before the arrival of an ambulance.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Data showed patient outcomes were better when compared to the locality and nationally.
• The practice carried out clinical audits. However, they were unable to demonstrate how clinical audits were driving quality improvement.
• Staff had the skills, knowledge and experience to deliver effective care and treatment. However, the practice was unable to demonstrate that locum GPs employed directly by the practice were up to date with attending mandatory courses or had received annual appraisals.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services was available.

• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity. However, some were not dated so it was not clear when they were written of if they were up to date.
• The practice had proactively sought feedback from patients and was in the process of recruiting patients to form a patient participation group.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of and complied with the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Ensure all infection control risks are assessed and action taken to reduce risk where possible.

• Ensure the practice is able to respond to a medical emergency in line with national guidance.

• Carry out clinical audits and re-audits to improve patient outcomes.
• Ensure all staff are up to date with mandatory training and receive annual appraisals.

In addition the provider should:

• Record domestic cleaning audits.

• Revise mix of staff to provide patients with the choice of seeing a female GP.

• Have a website and online access for patients to book appointments as well as order repeat prescriptions.

• Revise governance processes and ensure that all documents used to govern activity are up to date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice